Kidney disease and ketoanalogues. What’s the connection? Well, one of the more common concerns faced by people suffering from poor kidney function, and who’ve subsequently made the switch to a low-protein style of diet is, “What do I do about protein?” Keeping your protein levels balanced in accordance with the advice of your nephrologist is crucial to ensuring the best health possible, and one of the best options available for those with kidney problems comes in the form of Ketoanalogues.
What are Ketoanalogues? Ketoanalogues are amino acids that are supplemented in conjunction with lower protein diets and are super effective in improving one’s symptoms and supporting the benefits of a low protein kidney diet. When protein is broken down in the body into amino acids, you get waste byproducts and these are always cleared by the kidneys. Due to the effects of these wastes on the kidneys, most other doctors recommend using a modified protein intake as a sort of nutrition therapy to support kidney health and slow the progression of any lost kidney function.
Protein-modified diets fall into these three categories: VLPD’s or very low protein diets supplemented with ketoanalogues, low protein diets, and a plant-based vegetarian diet. The very low protein diets are around usually 20 grams of protein per day and low protein diets are about 40 grams of protein, but these vary on the person’s weight and height. Although the vegetarian renal diet is focused on getting out as much animal protein as possible.
In other words, Ketoanalogues allow a person with a very low protein diet to get all the benefits of quality amino acids without all the nitrogen processing downside on your kidneys, which your kidneys don’t need at all. If you’re following a very low protein diet, ketoanalogues are essential to your body because they support your nutritional therapy.
The research on Ketoanalogues supporting better outcome markers for kidney health and very low protein diets appears always consistently in most medical research. In a research paper written by Dr. Gang Lee Ko, on protein intake and chronic kidney issues, he identified about eight other different potential benefits of a low/very low protein diet. These benefits included the ability to slow down the decline of GFR, decrease proteinuria, decrease uremic toxins, decrease oxidative stress or inflammation, decrease metabolic acidosis, decrease phosphorus or parathyroid hormone, decrease insulin resistance, and finally decrease blood pressure. All of these benefits ultimately led to delaying dialysis initiation and the more dire effects of chronic kidney disease.
The very low protein diet supplemented with ketoanalogues is not usually a standard of medical practice in the United States. The majority of the nephrology community in America does not encourage or support the very low protein diet and ketoanalogues for four big reasons. One such reason is that unfortunately many nephrology professionals are unfamiliar with how to implement a very low protein diet + ketoanalogue regimen, as it typically requires a team effort with a dietitian, and renal dietitians can be hard to find. Another oft-cited reason is fear of malnutrition, as well as the availability of ketoanalogues and low protein foods to kidney health sufferers (i.e., ‘Is this a sustainable long-term plan they will keep up with?’).
As mentioned above, most renal dietitians work in dialysis centers and most people find it difficult to find one that offers private counseling. Added to these potential obstacles, renal dietitians may not be entirely comfortable with how to guide patients on this kind of diet on their own. Having a supportive medical team guarantees a higher rate of success. A nephrologist to monitor labs and medication and a renal dietitian to provide initial and extended counseling both on the new dietary and supplement regimen is really essential to guaranteeing the best outcome.
Dietary changes are never as simple as having the guidance of a professional to troubleshoot common daily problems, taking small steps makes all the difference in the world. There is not a lot of research on how the very low protein diet impacts the quality of life. However, unguided dietary restrictions drastically impact the quality of life. After working through sessions, people are much more confident about their food choices. Dietitians really are amazing coaches and cheerleaders for people making difficult dietary changes.
The other aforementioned reason we touched upon that many medical professionals are hesitant to recommend VLPDs is that very low protein diets carry with them the stigma of malnutrition, especially in terms of protein energy-wasting. Research has supported this, especially with the high prevalence of malnutrition rates in people with later-stage kidney disease. As the kidneys decline, there is a complex form of pathophysiological alterations that can definitely lead to malnutrition. However, for earlier-stage kidney disease, malnutrition is not as commonly seen. The most recent reviews in medical research don’t support very low protein diets being strongly associated with protein-energy wasting.
The aim of low protein diets for handling accumulation of protein waste products conservatively and delaying the need for dialysis treatment has been hampered by the fear of protein-energy wasting, yet none of the studied trials reported increased risk of protein-energy wasting or cachexia, despite lower protein intake, nor was there any safety issue in any of the trials. This is consistent with what the medical researcher’s Cochrane Review found in 12 of their reviewed studies. They state, “Twelve studies reported no evidence of protein-energy wasting (malnutrition) in their study participants, while three studies reported small numbers of participants in each group with protein-energy wasting.” There is research showing some worse outcomes with very low protein diets, but as Dr. Rhee states, they didn’t see those types of outcomes consistently. People that have a great working relationship with a renal dietitian to make the diet feasible primarily have better outcomes.
The final reason that very low protein diets haven’t been widely recommended in America is due to logistics. Ketoanalogues and low protein food products are not as readily available in the United States. Ketoanalogues need to be ordered from Central America or Europe for patients that really wanted to follow the very low protein diet with ketoanalogue supplementation. This was logistically and financially not feasible for many people.
Most ketoanalogues, like Albutrix, are calcium-based. Added calcium is a big deal for people with kidney disease both on the high and low end. As such, it’s recommended you talk with your doctor about monitoring calcium levels and cardiac calcification parameters when using a calcium-based ketoanalogue. Switching to a very low protein regimen is not as simple as just cutting out your grilled chicken. Nor is protein your only concern when it comes to dietary changes for supporting kidney health. The diet is a big change for most people with a large number of fruits, vegetables, healthy fats, and carefully selected carbohydrates and proteins.
Every single person is different and has different needs and preferences. Ideally, one should try to find a qualified dietitian to walk you through this and make sure your nephrologist knows you are planning to try a low protein dietary regimen with ketoanalogues. With any dietary change, it’s good to start by working with meals that people already eat and are familiar with. That means the dietitian gets a good idea of the person’s likes, dislikes, and daily routine, and then decides on how to stock the pantry and fridge for upcoming changes. It’s very difficult to follow any nutrition plan without having the right food available.
In that case, it’s better to have a pantry ready with the correct foods. Meaning, ordering low protein carbs like bread or pasta. It’s also recommended to make sure there are some fats available such as olive oil and avocado. With the very low protein diet, I also like to make sure that clients have a plan to stay stocked with daily ketoanalogue supplements, a good renal multivitamin with zinc, a probiotic, and a vitamin D3 + K2 supplement. The only common concerns are what to choose when eating out with family and friends, how to incorporate occasional favorite foods of that person, what to do when traveling, and what to eat if the day is too busy or if the person happens to be too tired to cook or follow through with a meal plan for the day.
One thing that is super important to understand is that ketoanalogues must be taken in tandem with a low protein diet. Ketoanalogues by themselves don’t support kidney health. They are meant to detour protein deficiency that results from a very low protein diet. It is the very low protein diet itself that is the therapy for kidney disease, the ketoanalogues are a supportive and necessary part of that routine or therapy.
If one eats a regular protein diet and adds ketoanalogues to it, there isn’t much benefit for the kidneys’ overall health. If you eat a vegetarian diet you’re only getting just enough protein. At that level of protein, you are basically meeting most of your basic protein needs for your body. Ketoanalogues are meant to be used with a normal-sized protein intake, so any intake around that amount is not recommended for using ketoanalogues. To get ketoanalogues, it’s best to usually buy straight from the manufacturer, because it guarantees a quality product. One of the most trusted names on the market is Albutrix, which we highly recommend! And be sure to visit our YouTube for all things kidney health, including videos on diets, supplements and more!